Provider Demographics
NPI:1932863115
Name:NGUYEN, CHRISTINE CONG HUYEN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CONG HUYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12732 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2848
Mailing Address - Country:US
Mailing Address - Phone:408-515-4818
Mailing Address - Fax:
Practice Address - Street 1:5312 BOLSA AVE STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1060
Practice Address - Country:US
Practice Address - Phone:818-247-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician